Endocrinology Flashcards

1
Q

Viruses that can trigger T1DM

A

Coxsackie B virus

Enterovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ideal blood glucose concentration

A

4.4-6.1mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

T1DM presentation

A
Polyuria
Polydypsia
Weight loss
Secondary enuresis
Recurrent infections 
Symptoms present 1-6weeks before developing DKA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bloods for T1DM

A

FBC, UE
Blood culture if fever
HbA1c
TFT, TPO to test for autoimmune thyroid disease
Anti-TTG for coeliac disease
Insulin antibodies, anti-GAD antibodies, islet cell antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of T1DM

A

Subcutaneous insulin regimes
Monitoring dietary carbohydrate intake
Monitoring blood sugar levels on waking, at each meal and before bed
Monitoring for and managing complications, both short and long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Insulin in T1DM

A

Background, long acting insulin given once a day
Short acting insulin given 30minutes before meals
Insulin pump
Cycle injection sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Insulin pump

A

Cannula pumps insulin into body
Replaced ever 2-3 days
To qualify: >12 and difficulty controlling HbA1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Advantages of insulin pump

A

Better blood sugar control
More flexibility in eating
Fewer injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Disadvantages of an insulin pump

A

Learning how to use pump
Having it attached at all times
Blockages in infusion set
Small risk of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types of insulin pumps

A

Tethered pump

Patch pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tethered pumps

A

Replaceable infusion sets and insulin
Attached to patients belt or around waist
Controls on pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patch pumps

A

Sit directly on skin without visible tubes
Entire patch has to be replaced
Controlled by separate remote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T1DM hypoglycaemia causes

A
Too much insulin
Not enough carbohydrates
Not processing carbohydrates properly
Malabsorption 
Diarrhoea
Vomiting
Sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypoglycaemia symptoms

A
Tremor
Sweating
Irritability
Dizziness
Pallor

Reduced consciousness
Coma and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of mild hypoglycaemia

A

Rapid acting glucose

Slower acting carbohydrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of severe hypoglycaemia

A

IV 10% dextrose:
2mg/kg bolus
5mg/kg bolus

IM glucagon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of hypoglycaemia

A
Hypothyroidism
Glycogen storage disorders
Growth hormone deficiency
Liver cirrhosis
Alcohol and fatty oxidation defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nocturnal hypoglycaemia

A

Sweating overnight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Long term macrovascular complications of hyperglycaemia

A

Coronary artery disease
Peripheral Ischaemia: poor healing, ulcers, diabetic foot
Stroke
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Long term microvascular complications of hyperglycaemia

A

Peripheral neuropathy
Retinopathy
Kidney disease, glomerulosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Infection-related complications of hyperglycaemia

A

UTI
Pneumonia
Skin and soft tissue infections, especially in the feet
Fungal infections, especially oral and vaginal candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

T1DM monitoring

A

HbA1c every 3-6 months
Capillary blood glucose
Flash glucose monitoring: Libre, checks glucose in interstitial fluid, 5 minute lag behind blood glucose. Need replacing every 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T2DM in children

A
Increased body weight 
Increased risk of renal complications
HTN
Dyslipidaemia
Increased cardiovascular risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T2DM treatment

A

Lifestyle modification
Paediatric dietician to optimise body-weight and blood glucose control
Anti diabetic drugs
>6 months influenza and pneumococcal immunisation

Target HbA1c: 48mmol.mol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Anti diabetic drugs in children
Only Metformin hydrochloride Increase dose gradually 3-4 months If not working, add long acting insulin or once-daily human isophane insulin
26
DKA main problems
Ketoacidosis Dehydration Potassium imbalance
27
Potassium imbalance DKA
``` No insulin to drive potassium into cells Serum K high, total K low Kidneys remove K as serum K is high Add insulin, hypokalaemia, low serum potassium Arrhythmias ```
28
Cerebral oedema DKA
``` Dehydration, high blood sugar Water moves ICF-> ECF in brain Brain cells shrink and become dehydrated Rapid correction of dehydration and hyperglycaemia ECF-> ICF Brain swells and becomes oedematous Brain cell destruction and death ```
29
Signs of cerebral oedema
Headaches Altered behaviour Bradycardia Changes to consciousness
30
Management for cerebral oedema
Slowing IV fluids IV mannitol IV hypertonic saline
31
Presentation of DKA
``` Hyperglycaemia, dehydration, acidosis Polyuria Polydipsia N/V Weight loss Acetone smell to breath Dehydration and subsequent hypotension Altered consciousness Symptoms of underlying trigger (sepsis) ```
32
DKA diagnosis
Blood glucose >11 Ketosis >3 mmol/l Acidosis pH<7.3
33
Principles of DKA management in children
``` Correct dehydration over 48 hours Fixed rate insulin infusion Avoid fluid boluses Treat underlying triggers Prevent hypoglycaemia: IV dextrose once blood glucose falls <14mmol/L Add potassium to IV fluids and monitor serum potassium closely Monitor for signs of cerebral oedema Monitor glucose, ketones and pH ```
34
Addison’s disease
Adrenal glands damaged Reduced cortisol and aldosterone secretion Primary adrenal insufficiency Autoimmune cause
35
Secondary adrenal insufficiency
Inadequate ACTH stimulating adrenal glands Low levels of cortisol released Congenital underdevelopment of pituitary gland Pituitary Hypoplasia, surgery, infection, loss of blood flow, radiotherapy
36
Tertiary adrenal insufficiency
Inadequate CRH released by hypothalamus | Long term oral steroids (>3 weeks) causing suppression of hypothalamus
37
Features of adrenal insufficiency in babies
``` Lethargy Vomiting Poor feeding Hypoglycaemia Jaundice Failure to thrive ```
38
Features of adrenal insufficiency in older children
N/V Poor weight gain or weight loss Reduced appetite (anorexia) Abdominal pain Muscle weakness or cramps Developmental delay or poor academic performance Bronze hyperpigmentation to skin in Addisons: high ACTH levels which stimulate melanocytes
39
Adrenal insufficiency investigations
UE: hyponatraemia, hyperkalaemia, hypoglycaemia | Test for cortisol, ACTH, aldosterone and renin levels
40
Addison’s disease hormone levels
Low cortisol High ACTH Low aldosterone High renin
41
Secondary adrenal insufficiency
Low cortisol Low ACTH Normal aldosterone Normal renin
42
Short synacthen test | ACTH stimulation test
Performed in morning when adrenal glands are most fresh Test involves giving synacthen Blood cortisol measured at baseline, 30 and 60 minutes after administration Cortisol level should at least be double in response to synacthen
43
Management of adrenal insufficiency
Replacement steroids Hydrocortisone for cortisol (glucocorticoid) Fludrocortisone for aldosterone (mineralocorticoid) Steroid card and emergency ID tag Increases doses in acute illness
44
Monitoring of adrenal insufficiency
``` Growth and development Blood pressure U&Es Glucose Bone profile VitaminD ```
45
During acute illness (sick day rules)
>38degrees temperature Vomiting and diarrhoea Dose of steroid increased and given more regularly Blood sugar needs to be monitored closely Need to eat food containing carbohydrates regularly D/V, need IM injection of steroid at home and likely required admission for IV steroids
46
Addisonian crisis
Acute presentation of severe Addisons Reduced consciousness Hypotension Hypoglycaemia, hyponatraemia, hyperkalaemia
47
Management of Addisonian crisis
``` Intensive monitoring Parenteral steroids IV fluid resuscitation Correct hypoglycaemia Careful monitoring of electrolytes and fluid balance ```
48
Polydipsia in children
Central diabetes insipidus Nephrogenic diabetes insipidus Diabetes mellitus TY1 Diabetes mellitus TY2
49
Puberty in males
First sign: testicular growth at 12 years Testicular volume >4ml indicates onset of puberty Maximum height spurt at 14
50
Puberty in females
First sign is breast development at 11.5 years of age Height spurt reaches maximum at 12, before menarche Menarche at 13
51
Normal changes in puberty
Gynaecomastia may develop in boys Asymmetrical breast growth may occur in girls Diffuse enlargement of the thyroid gland may be seen
52
Delayed puberty with short stature
Turner’s syndrome Prader-Willi syndrome Noonan syndrome
53
Delayed puberty with normal stature
Polycystic ovarian syndrome Androgen insensitivity Kallman’s syndrome Klinefelter’s syndrome
54
Precocious puberty
Development of secondary sexual characteristics before 8 years in females and 9 years in males More common in females Gonadotropin dependent, gonadotropin independent
55
Gonadotropin dependent precocious puberty
Due to premature activation of HPA axis | FSH/LH raised
56
Gonadotropin independent precocious puberty
Due to excess sex hormones | FSH/ LH low
57
Testes precocious puberty
Bilateral enlargement= gonadotropin release from intracranial lesion Unilateral enlargement- gonadal tumour Small tests: adrenal cause, tumour or adrenal hyperplasia
58
Organic causes of precocious puberty in females
Usually idiopathic or familial and follows normal sequence of puberty Organic cases are rare McCune Albright syndrome
59
Congenital adrenal hyperplasia
Congenital deficiency of 21-hydroxylase enzyme Underproduction of cortisol and aldosterone Over production of androgens from birth Autosomal recessive inheritance
60
Testosterone function
Androgen hormone High levels in men Low levels in women Promotes male sexual characteristics
61
Glucocorticoids function
Deal with stress, raise blood glucose, reduce inflammation, suppress immune system Cortisol: main glucocorticoid hormone Level of cortisol fluctuates during the day, higher levels in morning and during times of stress Released in response to ACTH from anterior pituitary
62
Mineralocorticoid hormones
Act on kidneys to control balance of salt and water in blood Aldosterone secreted by adrenals in response to renin Acts on kidneys to increase sodium reabsorption into blood and increase potassium secretion into urine Aldosterone acts to increase sodium and decrease potassium in the blood
63
Pathophysiology congenital adrenal hyperplasia
21-hydroxylase Converts progesterone into aldosterone and cortisol 21-hydroxylase deficiency Excess progesterone -> testosterone
64
Presentations in severe cases of CAH
Virilised genitalia: ambiguous genitalia and an enlarged clitoris due to the high testosterone levels Severe CAH: hyponatraemia, hyperkalaemia, hypoglycaemia Poor feeding Vomiting Dehydration Arrhythmias
65
Female patients mild CAH
``` Tall for their age Facial hair Absent periods Deep voice Early puberty ```
66
Male patients with mild CAH
``` Tall for their age Deep voice Large penis Small testicles Early puberty ```
67
Management of CAH
Cortisol replacement with hydrocortisone Aldosterone replacement, fludrocortisone Virilised genitals: corrective surgery
68
Congenital growth hormone deficiency
Disruption to growth hormone axis at hypothalamus or pituitary gland GH1 or GHRHR mutation Empty sella syndrome: pituitary gland is underdeveloped or damaged
69
Acquired growth hormone deficiency
Secondary to infection, trauma, surgical interventions
70
Multiple pituitary hormone deficiency
``` Hypopituitarism Hypothyroidism Growth hormone deficiency Adrenal insufficiency Gonadotropin ```
71
Presentation of GH deficiency in neonates
Micro penis Hypoglycaemia Severe jaundice
72
Presentation of GH deficiency in older infants and children
Poor growth, usually stopping or severely slowing from age 2-3 Short stature Slow development of movement and strength Delayed puberty
73
GH deficiency investigations
GH stimulation test: use glucagon, insulin, arginine or clonidine Thyroid and adrenal deficiency MRI brain for pituitary or hypothalamus abnormalities Genetic testing for Turner, Prader-Willi X-RAY or DEXA scan to determine bone age and help predict final height
74
Treatment of GH deficiency
Daily s.c. Somatropin (GH) Treatment of other associated hormone deficiencies Close monitoring of height and development
75
Congenital hypothyroidism
Dysgenesis or dyshormonogenesis | Newborn blood spot screening test
76
Congenital hypothyroidism presentation
``` Prolonged neonatal jaundice Poor feeding Constipation Increased sleeping Reduced activity Slow growth and development ```
77
Acquired hypothyroidism causes
Autoimmune thyroiditis (Hashimotos) TY1DM and coeliac associations Anti thyroid peroxidase antibodies and anti thyroglobulin antibodies
78
Symptoms of acquired hypothyroidism
``` Fatigue and low energy Poor growth Weight gain Poor school performance Constipation Dry skin and hair loss ```
79
Management of hypothyroidism
TFTs Thyroid ultrasound Thyroid antibodies Levothyroxine O.D.
80
Thyrotoxicosis in pregnancy
Increase in TBG, increase in levels of total thyroxine but doesn’t affect free thyroxine level Untreated thyrotoxicosis increases risk of foetal loss, maternal heart failure and premature labour Graves most common cause HCG can activate TSH receptor: transient gestational hyperthyroidism
81
Management of hyperthyroidism in pregnancy
First trimester: propylthiouracil Second trimester: carbimazole T3/4 levels checked, don’t want hypothyroidism in fetus TSH-receptor simulating antibodies check at 30-36 weeks
82
What BMI centile would you consider tailored clinical intervention for obesity?
>91st
83
When BMI centile would you consider assessing for obesity comorbidities?
>98th centile
84
Risk factors for obesity in children
Asian children Female children Taller children: >50th percentile in height
85
Cause of obesity in children
``` GH deficiency Hypothyroidism Down’s syndrome Cushing’s syndrome Prader-Willi syndrome ```
86
Consequences of obesity in children
Orthopaedic problems: SUFE, Blount’s disease, MSK pains Psychological consequences: poor self-esteem, bullying sleep apnoea Benign intracranial HTN TY2DM HTN Ischaemic heart disease